MVBCH Membership Form

Name

First NameLast Name

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Indicate Committees you're interested in - choose as many as you like

Other

Would you be willing to be a Committee Chair?

Membership Type

PHOTO RELEASE: I (We) agree to the use of my (our) images taken at Chapteractivities and events to be published in the monthly newsletter, on the website, in Chapter scrapbooks and/or at any Chapter function.

LIABILITY RELEASE: As per Colorado Revised Statute 13-21-119, an equine activity sponsor shall not be liable for an injury to or the death of a participant resulting from the inherent risks of equine activities. No participant or participant's representative shall make any claim against, maintain an action against, or recover from an equine activity sponsor or any other person for injury, loss, damage, or death of the participant resulting from any of the inherent risks of equine activities. I (We) release the Mesa Verde Back Country Horsemen, its officers, directors, members and agents of any and all liability which may arise as a result of injury to my (our) person or property that may be sustained in connection with the Chapter's activities.

Date

All persons 18 years and older included in this membership form must sign this release:

Signature

My Products

Membership$43.00

Membership Category

Total $0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info